Showing papers by "Sabine Sarnacki published in 1999"
TL;DR: Intestinal transplantation is indicated for patients with permanent intestinal failure and because parenteral nutrition is generally well tolerated, even for long periods, each indication for transplantation must be weighed carefully in terms of risk and quality of life.
Abstract: From November 1994 to November 1998, 20 children (2.5 to 14 years) received a jejunoileal graft alone (SBTx; n = 10) or in combination with the liver (SBLTx; n = 10 and/or the right colon (5 SBTx). Indications were intractable diarrhea of infancy (n = 8), short bowel syndrome (n = 6), extensive Hirschsprung disease (n = 4), and chronic intestinal pseudoobstruction (n = 2). Immunosuppression included tacrolimus, methylprednisolone, and azathioprine. Current follow-up ranges from 6 to 54 months. Five patients died (3 SBTx) within the first 2 months. Acute liver rejection occurred in 5 patients during the first 2 months. Sixteen episodes of intestinal rejection during the first 3 months in 11 patients (8 in 4 SBTx) were successfully treated in all but 3 by increasing tacrolimus dose and/or a 3-day methyprednisolone bolus or required antilymphoglobulins in 3 cases. Surgical complications occurred 8 times after SBLTx and 3 after SBTx. Infectious complications were more frequent in SBLTx recipients. Reversible Epstein-Barr virus-related posttransplant lymphoproliferative disease occurred in 3 recipients. Five presented cytomegalovirus infection. The SB graft was removed in 5 recipients (3 chronic rejection). All patients were started with oral and/or enteral feeding from the 7th postoperative day by using either normal food or protein hydrolysate diet. Currently, 10 of 11 children (8 SBLTx) achieved digestive autonomy after 5 to 30 weeks. All recipients gained weight; however, growth velocity remained reduced during the first 6 months because of the steroid therapy. Overall graft and patient survival is higher after SBLTx. Intestinal transplantation is indicated for patients with permanent intestinal failure. However, because parenteral nutrition is generally well tolerated, even for long periods, each indication for transplantation must be weighed carefully in terms of risk and quality of life.
38 citations
TL;DR: Intestinal transplantation is a valid therapeutic option for children with definitive intestinal failure and not only for short bowel syndrome and the lower severity of graft rejection in combined liver-small bowel transplantation improves functional results of intestinal transplantation in children without additional mortality or morbidity.
31 citations
Journal Article•
TL;DR: This technique has been shown to have a good balance between benefits and risks, especially in very young children, and experience with this technique should be continued and the use of cadaveric grafts should be optimized.
Abstract: Objectifs - La transplantation hepatique avec donneur vivant apparente est une technique recemment developpee pour pallier le manque de greffons disponibles chez les enfants. Le probleme majeur en est ethique, puisqu'elle necessite la mutilation volontaire d'un sujet sain. L'experience de 37 transplantations avec donneur vivant est rapportee. Malades - Les enfants receveurs etaient suivis a l'Hopital des Enfants-Malades, et les parents donneurs explores et pris en charge dans le service de chirurgie digestive de l'Hopital Beaujon. Resultats - Un des 37 donneurs a du etre reopere pour hemorragie, et un autre a eu une fuite biliaire traitee par drainage percutane durant une semaine. Aucun autre donneur n'a eu de complication avec un recul de 2 a 50 mois. Trente-trois enfants sont vivants (90 % de survie), l'un ayant du etre re-transplante pour thrombose arterielle. Les complications vasculaires et infectieuses et le nombre de rejets chez les receveurs ont ete voisins de ceux observes pour les transplantations realisees a partir de donneurs cadaveriques. Les complications biliaires ont ete frequentes (15 malades sur 37) et ont contribue significativement a la morbidite. Seul un adolescent ayant recu un petit greffon (0,9 % de son poids) a eu des signes d'insuffisance hepatique, mais sans encephalopathie. Conclusions - Le bon rapport benefices-risques de cette technique, etabli par plusieurs comites d'ethique, est retrouve dans notre experience, en particulier chez les plus petits enfants. Il reste toutefois indispensable de discuter individuellement chaque situation familiale et de veiller a la liberte de consentement des parents. Les bons resultats de la transplantation avec donneur vivant apparente incitent a poursuivre cette experience parallelement aux efforts entrepris pour optimiser l'utilisation des greffons cadaveriques disponibles.
5 citations
4 citations
TL;DR: L'anticorps anti-LFA-1 seul permet de prolonger significativement the survie des greffons, a condition that le traitement soit debute la veille de the greffe.
2 citations
01 Feb 1999
1 citations